Mental and gastrointestinal health associated with menopause symptoms


In a recent study, women with worse mental and gastrointestinal health had stronger menopausal symptoms.

Mental and gastrointestinal health associated with menopause symptoms | Image Credit: © loran4a - © loran4a -

Mental and gastrointestinal health associated with menopause symptoms | Image Credit: © loran4a - © loran4a -

Perceived stress and certain gastrointestinal symptoms are associated with symptoms of menopause in women, according to a recent study published in Menopause.


  • Perceived stress and gastrointestinal symptoms are linked to menopausal symptoms in women, as per a recent study published in Menopause.
  • Menopause typically occurs around the age of 50 to 52, and women spend a significant portion of their lives postmenopause.
  • Estrogen deficiency and changes in gonadal steroids play a role in menopausal symptoms, potentially involving the central nervous system (CNS).
  • Gut microbiota, influenced by stress, age, and female sex hormones, is also associated with CNS function and menopausal symptoms.
  • Factors such as sleep, physical activity, depression, and gastrointestinal health are related to the severity of menopausal symptoms in women. Clinicians are advised to consider these factors when managing menopausal symptoms in their patients.

As advancing medicine and health care allows individuals to live longer lives, the population of elderly people has grown. Menopause has a median age of 50 to 52 years, and most women spend 30% to 40% of their lives in postmenopause.

Data has indicated up to 80% of women experience symptoms of menopause, with some experiencing symptoms that persist multiple years postmenopause. Estrogen deficiency is a common factor associated with symptoms of menopause but decreases in gonadal steroids may be a source of Central Nervous System (CNS)-related menopausal symptoms.

The gut microbiota has also been associated with CNS function, and the gut microbiota is impacted by stress. Additionally, age and female sex hormones are factors linked to changes in the gut microbiota.

Investigators conducted a study to determine whether there is an association between menopausal symptoms, perceived stress, and gastrointestinal symptoms among midlife women. Participants aged 40 to 60 years completed an online survey conducted in Lithuanian.

There were 3 questionnaires included in the survey: the demographic and medical state questionnaire, the 10-item Perceived Stress Scale (PSS-10), and the Menopause-Specific Quality of Life Questionnaire (MENQOL). Factors of the survey included demographic and health status questions, questions about obstetric and gynecologic history, questions about gastrointestinal symptoms, and general health questions.

The PSS-10 analyzed when participants felt their life was unpredictable, uncontrollable, and overloaded. Items were graded on a 5-point Likert scale ranging from “never” to “very often.” Higher scores indicated increased perceived stress.

The MENQOL contained 29 items. Four domains were assessed: vasomotor, psychosocial, physical, and sexual. Higher scores indicated decreased quality of life.Participants were classified using Stages of Reproductive Aging Workshop +10 (STRAW10) classification, which evaluated reproductive aging.

There were 693 women included in the final analysis. Among these women, a significant association was found between STRAW10 stage and total MENQOL score, as well as vasomotor, physical, and sexual domain scores. At stage -3a, the total menstrual score was 2.97 ± 1.4, compared to 4.0 ± 1.5 and stage +2.

Total MENQOL school was not associated with age, education, tobacco use, number of pregnancies, or birth type. However, a significant association was found between body mass index and total MENQOL score. 

MENQOL scores were significantly reduced in women receiving more than 7 hours of sleep each night. Similar associations were found in the psychosocial and physical domains. 

Physical activity was also significantly associated with reduced total, vasomotor, physical, and psychosocial MENQOL scores. Significantly higher MENQOL scores were found in women diagnosed with depression and anxiety disorders.

Gastrointestinal factors significantly associated with total MENWOL score include defecation frequency and stool consistency. Defecation frequency was also associated with the physical domain, and stool consistency with the physical, vasomotor, and sexual domains. Associations were not found between time since last antibiotic use and MENQOL scores.

The average PSS score was 17.1 out of 34. Low stress was reported in 31% of participants, moderate in 59.6%, and high in 9.4%. A significant positive correlation was found between PSS score and total MENQOL score.

These results indicated associations between gastrointestinal factors and perceived stress with symptoms of menopause. Investigators recommended clinicians pay more attention to women’s mental and gastrointestinal health to manage menopausal symptoms.


Brimienė I, Šiaudinytė M, Burokas A, Grikšienė R. Exploration of the association between menopausal symptoms, gastrointestinal symptoms, and perceived stress: survey-based analysis. Menopause. 2023;30(11). doi:10.1097/GME.0000000000002259

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